Postpartum IUD Placement Safely Done in 1 Visit

Women who desire an intra - uterine device (IUD) after giving birth need not make an office visit to be assessed for pelvic inflammatory disease (PID) risk, ac - cording to a study presented at the 2011 American College of Obstetri cians and Gynecologists (ACOG) meeting.

“Two postpartum visits for IUD insertion are unnecessary,” said David R. Kattan, MD, MPH, of the University of Colorado, Aurora. “Our study found that PID rates in the postpartum population seeking IUDs were low, consistent with previous studies. We should adopt what ACOG already supports: a single-visit protocol for postpartum IUD insertion.”

Currently, the standard IUD placement protocol at many clinics includes a separate clinic visit to perform chlamydia and gonorrhea testing, with the placement visit 2 weeks later. The intent is to prevent IUD-associated PID, he noted.

“One possible solution to increasing successful follow-up and placement of IUDs is to eliminate this first visit and instead perform cervical sexually transmitted infection testing immediately prior to placement,” Dr Kattan observed.

Dr Kattan and colleagues reviewed the medical records of 1417 patients who received IUDs at his center in 2008 and identified 629 patients (average age, 25; average parity, 2.3) who had delivered babies up to 3 months before IUD placement.

A total of 98 women had positive chlamydia culture at any time before delivery and 37 patients had a positive culture during their pregnancy; 5 women had positive gonorrhea cultures before delivery, none of which occurred during the antepartum period. Postpartum testing revealed 5 cases of chlamydia and 1 case of gonorrhea.

Clinical examination showed PID in 3 women, none of whom had positive cervical cultures during the postpartum period or at the time of PID diagnosis. No women required hospital admission for treatment of PID or removal of their IUDs, Dr Kattan reported.

“Chlamydia and gonorrhea rates postpartum were both under 1% and were not predictive of IUD-associated PID,” he noted. “Our results support the elimination of an additional clinic visit prior to IUD placement, which may increase the delivery of IUDs to postpartum women seeking a reliable contraceptive.”